Government's single assessment process 'may damage care', says study
NSF policy 'dangerous'
A key element of Government referral policy is having potentially 'dangerous' effects by
sabotaging communication between primary and secondary care.
Patient care is likely to be suffering from introduction of the 'inflexible' single assessment process (SAP), a new evaluation has warned.
Researchers found the system, introduced to streamline referrals under the national
service framework for older people, had significantly damaged exchange of information.
An audit of referrals to psychiatrists conducted before and after introduction of single assessment forms found a dramatic fall in the proportion judged to be clinically useful.
Study leader Dr James Warner, honorary consultant in old age psychiatry at Imperial College London, called for the SAP to be dropped in its current form. He said: 'It is not working and may be dangerous in some circumstances. The impact of this could be considerable. Not all Government policies that seem attractive work in reality.'
Some 17 out of 20 traditional referral letters were judged to be clinically useful by two
senior clinicians, but this dropped to just three of 20 of the new referral forms.
The proportion providing enough information to judge the appropriateness of referral fell from 19 to five.
The audit, of referrals from GPs to an old age psychiatric service in north west London, found SAP forms took longer to read, were less legible and contained less information than traditional referral letters.
Writing in the journal Psychiatric Bulletin, the researchers warned: 'The single assessment process has impaired clinical communication between GPs and psychiatrists, and might be prejudicial to patient care.'
Dr Steve Iliffe, a GP in Kilburn, north-west London, and director of the Centre for Ageing Population Studies at University College London, said SAP forms had limited clinical or diagnostic use in mental health or other areas, and 'drowned people in information'.
Dr George Rae, secretary of Newcastle and North Tyneside LMC, said the research showed introducing forms and tick boxes didn't guarantee positive results. 'When you're making us go to certain questions and criteria, we're not getting the results we want.'